Trajectories of quality of life following breast cancer diagnosis
Although quality of life (QoL) improves over time for most breast cancer survivors (BCS), BCS may show different patterns of QoL. This study sought to identify distinct QoL trajectories among BCS and to examine characteristics associated with trajectory group membership.
BCS (N = 653) completed baseline assessments within 8 months of diagnosis. QoL was assessed by the Functional Assessment of Cancer Therapy-Breast (FACT-B) at baseline and 6, 12, and 18 months later. Finite mixture modeling was used to determine QoL trajectories of the trial outcome index (TOI; a composite of physical well-being, functional well-being, and breast cancer-specific subscales) and emotional and social/family well-being subscales. Chi-square tests and F tests were used to examine group differences in demographic, cancer-related, and psychosocial variables.
Unique trajectories were identified for all three subscales. Within each subscale, the majority of BCS had consistently medium or high QoL. The TOI analysis revealed only stable or improving groups, but the emotional and social/family subscales had groups that were stable, improved, or declined. Across all subscales, women in “consistently high” groups had the most favorable psychosocial characteristics. For the TOI and emotional subscales, psychosocial variables also differed significantly between women who started similarly but had differing trajectories.
The majority of BCS report good QoL as they transition from treatment to survivorship. However, some women have persistently low QoL in each domain and some experience declines in emotional and/or social/family well-being. Psychosocial variables are consistently associated with improving and/or declining trajectories of physical/functional and emotional well-being.
KeywordsQuality of life Breast cancer Survivorship Trajectories Psychosocial
This study was supported by National Cancer Institute Grant No. R25 CA122061 and Department of Defense Grant No. DAMD17-01-1-0447.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest to report.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
- 3.Institute of Medicine and National Research Council (2006) From cancer patient to cancer survivor: lost in transition. The National Academies Press, Washington, DC. https://doi.org/10.17226/11468
- 5.Karlsen RV, Frederiksen K, Larsen MB, von Heymann-Horan AB, Appel CW, Christensen J, Tjonneland A, Ross L, Johansen C, Bidstrup PE (2016) The impact of a breast cancer diagnosis on health-related quality of life. A prospective comparison among middle-aged to elderly women with and without breast cancer. Acta Oncol 55(6):720–727. https://doi.org/10.3109/0284186X.2015.1127415 CrossRefPubMedGoogle Scholar
- 6.Taira N, Shimozuma K, Shiroiwa T, Ohsumi S, Kuroi K, Saji S, Saito M, Iha S, Watanabe T, Katsumata N (2011) Associations among baseline variables, treatment-related factors and health-related quality of life 2 years after breast cancer surgery. Breast Cancer Res Treat 128(3):735–747. https://doi.org/10.1007/s10549-011-1631-y CrossRefPubMedGoogle Scholar
- 12.Dura-Ferrandis E, Mandelblatt JS, Clapp J, Luta G, Faul L, Kimmick G, Cohen HJ, Yung RL, Hurria A (2017) Personality, coping, and social support as predictors of long-term quality-of-life trajectories in older breast cancer survivors: CALGB protocol 369901 (Alliance). Psychooncology 26(11):1914–1921. https://doi.org/10.1002/pon.4404 CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Brady MJ, Cella DF, Mo F, Bonomi AE, Tulsky DS, Lloyd SR, Deasy S, Cobleigh M, Shiomoto G (1997) Reliability and validity of the Functional Assessment of Cancer Therapy-Breast quality-of-life instrument. J Clin Oncol 15(3):974–986. https://doi.org/10.1200/jco.1922.214.171.1244 CrossRefPubMedGoogle Scholar
- 14.Maratia S, Cedillo S, Rejas J (2016) Assessing health-related quality of life in patients with breast cancer: a systematic and standardized comparison of available instruments using the EMPRO tool. Qual Life Res 25(10):2467–2480. https://doi.org/10.1007/s11136-016-1284-8 CrossRefPubMedGoogle Scholar
- 16.Schou I, Ekeberg O, Sandvik L, Hjermstad MJ, Ruland CM (2005) Multiple predictors of health-related quality of life in early stage breast cancer. Data from a year follow-up study compared with the general population. Qual Life Res 14(8):1813–1823. https://doi.org/10.1007/s11136-005-4344-z CrossRefPubMedGoogle Scholar
- 21.Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, Silberman M, Yellen SB, Winicour P, Brannon J et al (1993) The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol 11(3):570–579. https://doi.org/10.1200/jco.19126.96.36.1990 CrossRefPubMedGoogle Scholar
- 22.Eton DT, Cella D, Yost KJ, Yount SE, Peterman AH, Neuberg DS, Sledge GW, Wood WC (2004) A combination of distribution- and anchor-based approaches determined minimally important differences (MIDs) for four endpoints in a breast cancer scale. J Clin Epidemiol 57(9):898–910. https://doi.org/10.1016/j.jclinepi.2004.01.012 CrossRefPubMedGoogle Scholar
- 29.Jones B. TRAJ: group-based modeling of longitudinal data. https://www.andrew.cmu.edu/user/bjones/index.htm. Accessed June 2017
- 33.Jutagir DR, Blomberg BB, Carver CS, Lechner SC, Timpano KR, Bouchard LC, Gudenkauf LM, Jacobs JM, Diaz A, Lutgendorf SK, Cole SW, Heller AS, Antoni MH (2017) Social well-being is associated with less pro-inflammatory and pro-metastatic leukocyte gene expression in women after surgery for breast cancer. Breast Cancer Res Treat 165(1):169–180. https://doi.org/10.1007/s10549-017-4316-3 CrossRefPubMedGoogle Scholar
- 35.Jim HS, Pustejovsky JE, Park CL, Danhauer SC, Sherman AC, Fitchett G, Merluzzi TV, Munoz AR, George L, Snyder MA, Salsman JM (2015) Religion, spirituality, and physical health in cancer patients: a meta-analysis. Cancer 121(21):3760–3768. https://doi.org/10.1002/cncr.29353 CrossRefPubMedPubMedCentralGoogle Scholar
- 36.Salsman JM, Pustejovsky JE, Jim HS, Munoz AR, Merluzzi TV, George L, Park CL, Danhauer SC, Sherman AC, Snyder MA, Fitchett G (2015) A meta-analytic approach to examining the correlation between religion/spirituality and mental health in cancer. Cancer 121(21):3769–3778. https://doi.org/10.1002/cncr.29350 CrossRefPubMedPubMedCentralGoogle Scholar
- 37.Andersen BL, DeRubeis RJ, Berman BS, Gruman J, Champion VL, Massie MJ, Holland JC, Partridge AH, Bak K, Somerfield MR, Rowland JH, American Society of Clinical O (2014) Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: an American Society of Clinical Oncology guideline adaptation. J Clin Oncol 32(15):1605–1619. https://doi.org/10.1200/JCO.2013.52.4611 CrossRefPubMedPubMedCentralGoogle Scholar
- 39.Andersen BL, Farrar WB, Golden-Kreutz DM, Glaser R, Emery CF, Crespin TR, Shapiro CL, Carson WE 3rd (2004) Psychological, behavioral, and immune changes after a psychological intervention: a clinical trial. J Clin Oncol 22(17):3570–3580. https://doi.org/10.1200/JCO.2004.06.030 CrossRefPubMedPubMedCentralGoogle Scholar
- 40.Antoni MH, Lehman JM, Kilbourn KM, Boyers AE, Culver JL, Alferi SM, Yount SE, McGregor BA, Arena PL, Harris SD, Price AA, Carver CS (2001) Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer. Health Psychol 20(1):20–32CrossRefPubMedGoogle Scholar
- 41.Smith SK, Herndon JE, Lyerly HK, Coan A, Wheeler JL, Staley T, Abernethy AP (2011) Correlates of quality of life-related outcomes in breast cancer patients participating in the Pathfinders pilot study. Psychooncology 20(5):559–564. https://doi.org/10.1002/pon.1770 CrossRefPubMedPubMedCentralGoogle Scholar
- 43.Stanton AL, Revenson TA, Tennen H (2007) Health psychology: psychological adjustment to chronic disease. Annu Rev Psychol 58:565–592. https://doi.org/10.1146/annurev.psych.58.110405.085615 CrossRefPubMedGoogle Scholar